We know that shielding is hard. At the moment, it’s still the best way for those in the highest risk group to stay safe from coronavirus.
We are basing our advice on evidence. It has been agreed by our clinical and scientific advisory groups.
We do not plan to ask people to shield forever. If infections rates in Wales continue to fall, we will look to pause shielding from 16 August. This is because we do not want people to carry on shielding if they do not need to.
The Chief Medical Officer for Wales will write to everyone who is shielding before the 16 August to advise them what to do next.
Planned changes from 16 August
From 16 August, we will pause shielding for everyone on the shielding list (children and adults) unless the number of COVID-19 cases in the community starts to rise significantly.
From 16 August, you’ll be advised you can go out to more places and see more people, for example, the advice is:
- you can go to work, as long as the workplace is COVID-secure – but carry on working from home if you can
- you can go outside to buy food, – keeping 2 metres (or 3 steps) away wherever possible. (Those who are receiving food boxes will continue to receive them until 16 August after which date they will cease but priority shopping slots will continue to be available).
- children and young people can go back to school or college/university.
This guidance will be updated with these changes on 16 August.
What if COVID-19 cases rise in Wales in the future?
Although we are planning relaxations, we do need to be prepared to advise people to shield in the future if needed.
We will keep a record of everyone on the shielded patients list should we need to ask anyone to shield again in future.
Going forward we want to have a better understanding of each individual’s personal risk. We are currently working with the UK to develop a tool that will allow doctors to assess an individual’s risk and what actions they should take to help lower the risk.
Children and young people
From 16 August, children and young people no longer need to shield which means they can go back to school or college/university.
There is strong evidence that suggests many children and young people do not need to shield at any time because, in general, children and young people have a much lower risk of severe illness from COVID-19. There are also health risks with shielding if people do not need to, such as the impact of not being in school.
There are around 5,000 children and young people on the shielded patients list in Wales.
We expect that the majority of children will be removed from the shielding list and we are considering the process for doing this. This means they would not be asked to shield again in the future. We expect that only those on certain treatments, such as for cancer care or those at risk of severe infection due to an immunodeficiency will stay on the shielding list and so may be advised to shield again in the future.
Who is this guidance for?
This guidance is for people, including children, who are at high risk of developing serious illness if they are exposed to coronavirus (COVID-19) because they have a particular serious underlying health condition (these are listed below).
It is also for their families, friends and carers.
The guidance is for use by people who are shielding in their own home or as part of an extended household, or are in long-term care facilities.
All those identified as being at high risk of severe illness from coronavirus (due to a serious underlying health issue) will receive a letter from the Chief Medical Officer for Wales. This is known as a ‘shielding letter’.
The Chief Medical Officer for Wales’ advice remains that those who are shielding should continue to do so until the 16 August 2020. A letter has been sent to everyone in Wales who is shielding which provides the current advice and information. The Chief Medical Officer for Wales will write again to those who are shielding advising what to do after 16 August 2020 when shielding is paused.
If you have been shielding you can form an extended household with another household. However, physical distancing within an extended household should continue where possible.
Those who are shielding can continue to leave home to exercise or meet outside with people from another household.
You should strictly follow physical distancing (2 metres or 3 steps away from another person) and you should practice good hygiene, washing hands or using a hand sanitiser and avoiding touching things touched by others.
Shielding is for your protection. We strongly advise you to follow this guidance but it is your decision to make. This will be a deeply personal decision and we would advise you to speak to your family and friends about this, and with your healthcare professionals, if necessary.
What do we mean by 'extremely vulnerable'?
Extremely vulnerable refers to people in Wales who have one of a very specific list of pre-existing and long-term serious health conditions.
Based on what we know so far the impact of their pre-existing, long-term health condition on their immune system puts them at high risk of serious illness if they are exposed to coronavirus.
We are currently asking this group of people to take a series of special measures, called "shielding", to protect themselves from getting ill.
People in this group include:
- Solid organ transplant recipients
- People with specific cancers:
- People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
- People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
- People having immunotherapy or other continuing antibody treatments for cancer
- People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
- People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
- People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe Chronic Obstructive Pulmonary Disease (COPD)
- People with severe single organ disease (e.g. Liver, Cardio, Renal, Neurological).
- People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as Severe Combined Immunodeficiency (SCID), homozygous sickle cell).
- People on immunosuppression therapies sufficient to significantly increase risk of infection.
- Pregnant women with significant heart disease, congenital or acquired.
- Children up to the age of 18 with significant heart disease, congenital or acquired.
If you believe you fall into one of the categories of extremely vulnerable people listed above and you have not received a letter, you should discuss your concerns with your GP or hospital doctor.
Things you should be doing to stay safe
- Do consider whether you wish to form an extended household and speak with your friends and family about how this could work in practice whilst keeping you safe.
- Do keep 2m or three steps away from other people outside your home and within your home or extended household. This will be more difficult if you live with or are part of an extended household with others, but you should try to do it as best you can.
- Do leave your home to undertake exercise if you want to. You can leave your home to exercise outside as many times as you want to, but try to avoid busy places so you can keep 2m or three steps away from other people.
- Do travel further than 5 miles from your house (as far as you want) but try to avoid busy places where it may be difficult to keep 2m or three steps away from people.
- Do meet outside with people from another house if you want to (outside of your extended household) but always keep 2m or three steps away.
- Do regularly wash your hands with soap and water for 20 seconds.
- Do ask neighbours, friends and family to bring you food and medicine.
- Do contact your local supermarket for priority online shopping.
- Do keep in touch with people using the phone, internet and social media.
- Do use telephone or online services to contact your GP, pharmacy or other day-to-day services.
- Do contact your local council if you have no one who can help you. The number is at the end letter from the Chief Medical Officer for Wales.
- Do review your support arrangements if you have formed an extended household. Where food boxes are no longer needed these should be cancelled. You can cancel your food box by calling the special number for your local authority. You can find the number in the letter you received from the Chief Medical Officer. Where medicine deliveries are no longer needed, please contact your pharmacy to inform them.
Things you should not be doing to stay safe
- Do not get close to anyone who is showing signs of coronavirus. This could be any or all of the following: high temperature (above 37.8 °C), a new and continuous cough, a loss of or change to your sense of smell or taste.
- Do not attend any gatherings indoors outside of your extended household. This includes gatherings of friends and families – for example, in family homes or weddings and religious services.
- Do not go out shopping. When arranging food deliveries, these should be left at the front door.
- Do not go to your GP, pharmacy or hospital without phoning first. You should speak to your pharmacy about how you can get your medicine.
- Do not go to your place of work if this is outside your home. You should only work if you can work from home.
- Do not go to school. You should learn from home.
What about my work?
If you are employed, please show the shielding letter from the Chief Medical Officer for Wales (or your GP) to your employer. You should not go to your normal place of work – you will need to work at home until the 16 August 2020, if you can do so. You do not need to get a fit note from your GP.
After 16 August you should be able to return to work, if infection rates remain low in Wales, and your workplace is COVID Secure. Your employer should help you to transition back to work safely and must take all reasonable measures to minimise exposure to coronavirus by ensuring a 2m distance is maintained between workers in your workplace (if you can’t work from home). The Welsh Government has already issued guidance to employers on taking measures to make the workplace safe.
Employers should be mindful of the particular needs of different groups of workers or individuals.
It is breaking the law to discriminate, directly or indirectly, against anyone because of a protected characteristic such as age, sex or disability, race or ethnicity.
Employers also have particular responsibilities towards disabled workers and those who are new or expectant mothers.
You can get advice on your specific situation and your employment rights by visiting the Acas website or calling the Acas helpline, 0300 123 1100.
If you have concerns about your health and safety at work, you can raise them with any union safety representatives, or ultimately with the organisation responsibility for enforcement in your workplace, either the Health and Safety Executive or your local authority.
If you are self-employed support is available through the Self-employment Income Support Scheme.
If you need help from the welfare system visit Understanding Universal Credit on GOV.UK.
What should you do to help stop the spread of germs?
Here are some simple guidelines to follow to help prevent the spread of germs; including viruses:
- Wash your hands more often - with soap and water for at least 20 seconds, or use a hand sanitiser. Do this after you blow your nose, sneeze or cough, and before after you eat or handle food.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact with people who have symptoms
- Cover your cough or sneeze with a tissue, then throw the tissue in a bin.
- Clean and disinfect frequently touched objects and surfaces in the home.
What should you do if you develop possible symptoms of coronavirus (COVID-19)?
If you develop any of the symptoms of COVID-19:
- a high temperature (above 37.8 °C)
- new and continuous cough
- loss of or change to your normal sense of smell or taste
seek clinical advice using the online coronavirus service or, if you do not have access to the internet, call 111.
In an emergency, call 999 if you are seriously ill. Do not visit the GP, pharmacy, urgent care centre, or a hospital.
To help the NHS provide you with the best care if you need to go to hospital as a result of catching coronavirus, please prepare a single hospital bag. This should include your emergency contact, a list of the medications you take (including dose and frequency), any information on your planned care appointments and things you would need for an overnight stay (snacks, pyjamas, toothbrush, your medication etc). If you have an advanced care plan, please include that.
What should you do if you live with someone or are part of an extended household?
The rest of your household do not need to start shielding themselves but they should do what they can to support you and they must follow guidance on social distancing.
At home or with your extended household you should:
- Minimise the time you spend with others in shared spaces such as the kitchen, bathroom and sitting area, and keep the rooms you share well ventilated.
- Aim to keep 2 metres (3 steps) away from others, and sleep in a separate bed where possible.
- Use separate towels and bathrooms. If you share a bathroom, clean it after every use. Consider creating a rota for bathing, with you using the facilities first.
- Avoid using the kitchen at the same time as others, and eat your meals in separate rooms. Ensure all kitchenware is cleaned thoroughly.
Everyone must regularly wash their hands with soap and water for 20 seconds, avoid touching their face, and clean frequently touched surfaces.
We know it will be difficult for some people to lead separate lives – you should try to follow this advice as far as you can. There is no need for other members of your household or extended household to following the shielding measures themselves.
If you cannot order food shopping on the internet and do not have any support from family, friends, neighbours or support groups close by who can help you while you are shielding, you can request a free weekly food box delivery. Each food box will contain enough food for one person shielding for a week – if two people in a household are shielding, you will be able to request two boxes.
To request a free weekly food box, please call the special number for your local authority, which is contained in the letter you received from the Chief Medical Officer.
The food box will be delivered directly to your home. Local authorities also have arrangements in place to help people who are in immediate need – before the deliveries begin.
The box will contain essential foods in packages and tins but only limited fresh produce. We are not able at the moment to meet people’s dietary needs including allergies. All the contents will be labelled so will need to be checked very carefully. We are looking to see if we can meet people’s dietary needs, including allergies, in the future, and hope to improve the variety.
A box will provide food and essentials for one person for one week. If there are two eligible people in the house, there will be two boxes.
Major supermarkets now have the details of all those who have received a shielding letter to enable them to prioritise internet orders for those who are shielding. More information can be found at Getting food and essential supplies.
If you are staying at home and someone is shopping for you, some supermarkets sell gift cards and vouchers that can be used to pay for shopping. These can be purchased online by the person staying at home and used by the person who goes to the shop.
If you have requested a weekly food box and your circumstances have changed, please consider whether you still need to receive it. For example, you might now have a priority online delivery slot or support from friends, relatives or volunteers. Or you may decide to become part of an extended household.
If you no longer need to receive the box please call the special number for your local authority to ask to cancel it. You can find the number in the letter you received from the Chief Medical Officer.
Those who are receiving food boxes will continue to receive them until 16th August after which date they will cease. Priority shopping slots will continue to be available.
The volunteer medicine delivery scheme will be available until the end of September.
Where medicine deliveries are no longer needed, please contact your pharmacy to inform them.
To help reduce risk you should continue to avoid visiting a pharmacy. If you have been having your medicines delivered and have formed an extended household, consider if one of these people can now pick up your prescription. This will help pharmacies to prioritise medicine deliveries to patients who have no-one to help them.
If you do not have anyone to help pick up your prescription, you can contact your pharmacy to ask them for advice on how to get your medicines
You may also need to arrange any specialist medication prescribed to you by your hospital care team to be collected or delivered to you.
What should you do if you have hospital and GP appointments during this period?
We are advising everyone to access appointments over the phone or internet, wherever possible. However, if you have a scheduled hospital or other medical appointment, talk to your GP or doctor to ensure you continue to receive the care you need. It is possible that your hospital may need to cancel or postpone some clinics and appointments.
What is the advice for visitors, including those who are providing care for you?
Visits from carers or healthcare workers, who would normally come and help with your daily needs or social care, will be able to carry on as normal. But carers and care workers must stay away if they have any of the symptoms of coronavirus:
- a high temperature (above 37.8 °C)
- new and continuous cough
- loss of or change to normal sense of smell or taste
Everyone coming into your home must wash their hands with soap and warm water for at least 20 seconds on arrival to your house, and frequently while they are in your home.
The advice for formal carers is included in the home care provision guidance on GOV.UK.
You should contact regular visitors to your home, such as friends and family to let them know that you are shielding and they should not come into your home during this time, unless they are providing essential care for you. Members of your extended household do not count as visitors. Essential care includes things like help with washing, dressing, or feeding.If you receive essential care from friends or family members, speak to your carers about extra precautions they can take to keep you safe.
It is a good idea to speak to your carers about what happens if one of them becomes unwell, and consider a back-up plan. If you don’t have friends or family who can help you, there are local community groups who may be able to help. If you can’t access a local community group, you can contact your local authority for advice – contact details for each local authority are included in the letter from the Chief Medical Officer for Wales.
What is the advice for informal carers who provide care for someone who is extremely vulnerable?
If you are caring for someone who is extremely vulnerable, there are some simple steps that you can take to protect them and reduce their risk of being exposed to coronavirus:
- Only care that is essential should be provided.
- Wash your hands on arrival at their home and often whilst there, using soap and water for at least 20 seconds, or use hand sanitiser.
- Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze.
- Put used tissues in the bin immediately and wash your hands afterwards.
- Do not visit or provide care if you are unwell, but make alternative arrangements for their care.
- Provide information on who they should call if they feel unwell, how to use the online coronavirus service, and leave the 111 number prominently displayed.
- Find out about different sources of support that could be used and access further advice on creating a contingency plan which is available from Carers UK.
- Look after your own well-being and physical health during this time. Further information on this is available further below.
How to look after your mental wellbeing
Shielding and distancing can be both boring and frustrating. You may find your mood and feelings are affected and you may feel low, worried, or have problems sleeping, and you might miss being outside and among other people. This is one of the reasons why we are now advising that those who are shielding can form an extended household and leave their home to exercise, or meet outside with people from another household providing they strictly socially distance and practice good hygiene.
At times like these, it can be easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse. There are simple things you can do that may help to stay mentally, and physically, active during this time, such as:
- Spend time doing things you enjoy – this might include exercising outside, reading, cooking, other indoor hobbies or listening to/watching favourite radio or TV programmes.
- Try to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and recreational drugs.
Further information on looking after your mental health and wellbeing is available on the Public Health Wales website.
Constantly watching the news can make you feel more worried. If you think it is affecting you, try to limit the time you spend watching, reading, or listening to media coverage of the outbreak. It may help to only check the news at set times or limiting this to a couple of times a day.
If you are receiving services for your mental health, learning disability or autism and are worried about the impact of isolation, please contact your keyworker/care coordinator or provider to review your care plan. If you have additional needs please contact your key worker or care coordinator to develop a safety or crisis plan.
If you have a learning disability and need some support understanding the shielding letter you can contact the Wales Learning Disability Helpline on 0808 8000 300 – it is free to phone and is open from 9am to 5pm every day including bank holidays. You can also email email@example.com
There are also services to support you and others you might be worried about. Talking about worries and problems can make things easier.
The C.A.L.L. Helpline is a dedicated mental health helpline for Wales. It provides confidential listening and emotional support and can help you contact support in your local area, including voluntary and charitable organisations. It is available on 0800 132 737, or by texting ‘help’ to 81066. Alternatively visit the C.A.L.L. website.
If you are still struggling after several weeks and it is affecting your daily life, please contact NHS Direct Wales or call 111.
What steps can you take to stay connected with family and friends during this time?
Draw on support from friends, family and other support networks outside of your extended household. Try to stay in touch with those around you over the phone, by post, or online.
Let people know how you would like to stay in touch and build that into your routine. This is also important in looking after your mental wellbeing and you may find it helpful to talk to them about how you are feeling, if you want to.
Remember, it is ok to share your concerns with others you trust, and in doing so you may end up providing support to them too. You may also want to contact the C.A.L.L. helpline on 0800 132 737, or by texting ‘help’ to 81066. Alternatively visit the C.A.L.L. website.
What is the advice for people living in long-term care facilities, either for the elderly or persons with special needs?
This advice also applies to extremely vulnerable people living in long-term care facilities.
Care providers should carefully discuss this advice with the families, carers and specialist doctors looking after residents to ensure this guidance is strictly followed.
What is the advice for parents and schools with extremely vulnerable children?
The advice also applies to children in mainstream and special schools. Children who are at high risk should not attend school but should continue to learn from home.
If you live with a child who is high risk you should try to follow the advice on living with other people and you should continue to have physical contact to provide essential care.